B1 Flashcards

Question

Describe the management of pleural effusion

Answer 1

1) Aspiration of pleural fluids ( thoracentesis ) - done to alleviate dyspnoea 2) Treat the underlying cause

Answer 2

The commonest cancer in men ( lung cancer ) The commonest cancer in women is ( breast cancer ) with ( lung cancer ) being second

Answer 3

Liver - most common Adrenals Brain Bone Kidney

Answer 4

Metastasis of kidney cancer to the lungs present itself as ( “cannon ball” lesion / cannon ball metastasis)

Answer 5

1) Due to primary effect of tumor - dyspnoea - cough with streaks of blood in sputum - pleuritic chest pain - pleuritic effusion - wheezing - fever 2) Due to invasion into thorax - dysphagia ( compression on oesophagus ) - dysphonia / hoarseness ( compression of laryngeal nerves ) - chest pain - SVC syndrome 3) Due to metastasis to distant sites -lymphadenopathy - bone pain - jaundice - kidney failure - neurological deficits ( seizures , dizziness , headaches ) 4) systemic symptoms - paraneoplastic syndrome — Cushing’s , hypercalcemia - anorexia , weight loss , weakness - clubbing of finger 5) Horner’ syndrome

Answer 6

Lung cancer can be divided into 2 : ( small cell lung cancer ( SCLC) ) & ( non- small cell lung cancer ( NSCLC) ) ( Non- small cell lung cancer ) can be further divided into 3 types ( adenocarcinoma , large cell carcinoma and squamous cell carcinoma ) ( Non - small cell lung cancers) occurs more frequently than ( small cell lung cancers) and they grow fairly slowly , compared to ( SCLCs ) which grow faster but occur less often.

Answer 7

In tuberculous lymphadenitis , the ( supraclavicular and posterior cervical ) group of lymph nodes become enlarged and matted. It can lead to a ( collar stud) abscess and sinus formation

Answer 8

( M . Avium complex ) is a complex agent of opportunistic TB infection

Answer 9

JONES CRITERIA Major Manifestation - Carditis ( friction rub , murmur , cardiomegaly , CHF ) - Arthritis ( migratory polyarthritis , swollen , red , tender ) - Chorea ( this describe inflammation of the central nervous system ) - Subcutaneous nodules ( lumps under the skin ) - Erythema marginatum ( rash ) Minor manifestation - Clinical : Fever , Arthralgia , History of rheumatic fever or rheumatic heart disease - Laboratory : ESR & C -reactive proteins raised , leukocytosis : Characteristic ECG changes - ( Prolonged P-R interval Diagnosis is made when : I) 2 major criteria is met II) 1 major + 2 minor + history of strep. Infection

Answer 10

Acute rheumatic fever usually affects children and young adults b/w the age of ( 5 - 15 years ) with evidence of preceding ( group A streptococcal ) pharyngitis.

Answer 11

In acute rheumatic fever , ( aspirin ) can be given to relieve the symptoms of arthritis rapidly , and a response within 24hrs helps to confirm the diagnosis.

Answer 12

-WBC count and ESR is elevated - Anti Streptolysin- O titer is elevated in 95 of patients -> 200 units in adults and > 300 units in children. - C -reactive protein is positive - Cardiac enzymes levels may increase in severe carditis ( These include the creative kinase ( CK ) & the proteins troponin I ( Tnl ) and troponin T ( TNT ) are linked with injury of the heart muscle. - Throat cultures continue to show presence of GABS ( group A beta haemolytic streptococci ) ; however they usually occur in small number. Isolating them is difficult.

Answer 13

1) Bed rest until inflammation subsides 2) Antibiotic therapy - IM benzathine penicilin ( 1.2m units ) every 3-4 wks - Oral penicillin ( 250mg ) 4x daily for 10 days - erythromycin or sulfadiazine if allergic to penicillin 3) Anti-inflammatory - aspirin - corticosteroids

Answer 14

Benzathine penicillin ( 1.2 m units ) every 3-4 wks IM Or Oral penicillin 250mg 2x/day If allergic - erythromycin 250 mg 2x / day orally 1) Prophylaxis should be done for 5 years or until 21 yrs of age ( whichever is longer ) 2) 10 years or into adulthood 3) 10 years since last episode or until 40 y of age ( sometimes lifelong )

Answer 15

Duke’s CRITERIA Major Criteria - 2 separate positive blood cultures with microorganism typical for infective endocarditis ( viridans streptococci , streptococcus bovis , HÁČEK group , staphylococcus aureus , enterococci ) - Echocardiographic evidence of endocardial involvement ( typical valvular lesion : vegetations , abscess or partial dehiscence of a prosthetic valve ) Minor criteria - Predisposition : predisposing factor heart condition or IV drug use - Temperature > 38C - Vascular phenomena : major arterial emboli , septic pulmonary infarcts , mycotic intracranial haemorrhage , conjunctival haemorrhage , Janeway lesion Immunological phenomena :glomerulonephrotis , Osler nodes , Roth spots , rheumatoid factor. Microbiological evidence : positive blood culture but not meeting major criterion , or serologic evidence of active infection with organism consistent with infective endocarditis ^^ 2 major criteria , 1 major criteria and 3 minor criteria , 5 minor criteria ^^ Blood cultures should be taken at 3 separate times ( 30 m apart ) at 3 different sites , before commencement of antibiotic therapy

Answer 16

1) Prosthetic valves 2) Prior IE 3) Congenital cyanosis heart disease 4) Patent ductus arteriosus 5) Aortic stenosis , aortic regurgitation , MR , MS with MR 6) Coarctation of aorta 7) Ventricular septal defect ( hole on heart ) 8) Surgical systemic-pulmonary shunts 9) Cardiac transplant recipients who develop valvulopathy 10) Rheumatic heart disease

Answer 17

Signs - Fever - Cardiac consequences : Heart murmur , heart failure , blocks Nonspecific signs : Anemia , Petechiae , Subungual or “splinter” haemorrhages, clubbing , splenomegaly , subconjunctival haemorrhages , Neurologic changes - meningitis , intracranial bleed More specific signs : Osler’s Nodes , Janeway lesions , Roth Spots.

Answer 18

1) Blood cultures - 3 samples from 3 different sites and 3 different times ( 30m intervals ) to assess for constant bacteremia - should be done before antibiotics treatment 2) Electrocardiography - to detect conduction disturbances 3) Echocardiography - to detect vegetation , valvular dysfunction ,abscess formation 4) CXR - detect cardiomegaly , heart failure , pulmonary edema 5) Raised CRP , ESR 6) Leucocytosis 7) Microscopic hematuria, proteinuria 8) Normocytic normochromic anemia

Answer 19

- usually occur in pre-existing cardiac condition where there is turbulent blood flow ( subacute IE -> S. viridans ) + bacteremia , but may also occur in healthy cardiac tissue ( acute IE -> S. aureus ) - high pressure blood flow injuries the heart valves , endocardium -> lead to accumulation of platelet & fibrin , leading to formation of thrombus - Bacteria introduced to bloodstream during surgical procedures ( dental , urological, skin ) leads to colonisation of the sterile vegetation - vegetation may cause obstruction leading to damage of valves & abscess or embolism.

Answer 20

State the causative agents of : Subacute IE : ( S . viridans ( S.mitis , S . sanguis ) , HÁČEK group , Candida , rickettsia , chlamydia , anaerobes ) Acute IE : ( S . aureus ) IE due to IV drug abuse : ( S. aureus , C .albicans ) Prosthetic valve endocarditis : ( S. epidermis )

Answer 21

State the areas for auscultation for : 1) Apex beat : ( 5th LICS near mid-clavicular line ) 2) Tricuspid : ( 5th LICS near sternum ) 3) Pulmonary area : ( 2nd LICS near sternum ) 4) Aortic area : ( 2nd RICS near sternum )

Answer 22

-site of aortic arch - site of carina of trachea - site of attachment of 2nd rib - site of bifurcation of pulmonary trunk - location of left recurrent laryngeal nerve

Answer 23

1) Coronary angiography - to demonstrate anatomy & patency of arteries 2) ECG - shows evidence of ischemia ( ST depression , T wave inversion ) , infarction ( ST elevation , Q waves ) , Hypertrophy of ventricles or arrhythmias 3) Exercise tolerance test 4) CXR - signs of cardiac failure ( cardiomegaly , pleural effusion , pulmonary edema ) 5) Echocardiogram 6) Cardiac enzyme assay - Troponin I , Troponin T - raised levels indicate MI 7 ) Coronary flow reserve 8) Myocardial fractional flow reverse 9) Screening for risk factors of atherosclerosis ( serum lipids , glucose levels , HbA1c , CRP , CBC )

Answer 24

Lifestyle changes - exercise - stop smoking - adopt healthy diet rich in fruits & vege - maintain healthy body weight - less alcohol consumption Medications - antiplatelet drugs ( Clopidogrel , aspirin ) - antihypertensive ( beta-blocker , ACEi ) - statin drugs - oral antidiabetic agents to maintain blood glucose ( metformin , glicazide ) - CCBs ( verapamil , diltiazem , amlodipine ) Surgical intervention - coronary artery bypass graft - coronary angioplasty

Answer 25

Prevent - avoid heavy meals - avoid stress - avoid extremely cold weather - stop smoking , drinking alcohol - maintain ideal body weight - exercise but with caution Treatment -low dose aspirin or Clopidogrel ( 75mg ) daily - sublingual GTN ( 0.4-0.6 ) for acute relief , for long term : Isosorbide nitrate 10-20mg 8th hourly - B-blocker - CCB - antifibrinolytics ( streptokinase , TPA ) in case of MI

Answer 26

( Stable ) angina occurs on exertion and is relieved by rest and medication. The pain usually does not increase in frequency and usually lasts for a short duration ( 1-5mins , <5min usually ) ( Unstable ) angina occurs at rest and is not relieved by rest . It presents with increasing frequency and intensity of pain and can last up 30 mins Angina occurs due to ischemia of the heart secondary to CAD , If the atherosclerotic plaque ruptures , it leads to platelet activation , adhesion & aggregation which leads to occlusion of the coronary artery & may lead to MI.

Answer 27

1. Intense emotional stress 2. Exercise & exertion 3. Heavy meals 4. Extremely cold weather 5. Thyroid disease 6. Nightmares ( nocturnal angina ) 7. Anemia

Answer 28

(Blood Pressure Category) ( Systolic mmHg) (Diastolic mmHg ) I) Normal , less than 120 and less than 80 II) Elevated , 120-129 and Less than 80 III) high blood pressure ( hypertension ) stage 1 , 130-139 or 80-89 IV) High blood pressure ( Hypertension ) stage 2 , 140 OR HIGHER or 90 or higher V) Hypertensive crisis , higher than 180 and/or higher than 120

Answer 29

1) Essential hypertension - genetic predisposition , ethnicity , gender - enviromental factors : high salt intake , obesity , diabetes ( insulin resistance ) , high BMI , high alcohol intake , sympathetic overactivity, smoking m sedentary lifestyle. 2)Secondary hypertension ( ABCDE) - hyperaldoteronism - bad kidney / renal failure : glomerulonephritis , pyelonephritis - coarctation of aorta - drugs : oral contraceptives , sympathetic agents , corticosteroids - endocrine disturbance : pheochromocytoma , Cushing syndrome , acromegaly , hyperthyroidism -pregnancy - sleep apnea

Answer 30

1) CVS manifestations I) left ventricular Hypertrophy II) Left heart failure III) Accelerated atherosclerosis -> coronary artery disease , periphery artery disease 2) On brain ( cerebralvascular disease ) I) stroke II) transient ischemic attacks III) hypertensive encephalopathy 3) On kidney - kidney failure 4) On eyes - hypertensive retinopathy -> retinal haemorrhage -> blindness

Answer 31

1) Aegophony 2) Dullness on percussion 3) Diminished chest expansion 4) Increased tactile vocal fremitus - Tactile fremitus refers to the palpable vibration of the chest wall that results from. The transmission of sound vibration through the lungs tissue to the chest wall 5) Pleural rub 6) Whispering pectoriloquy

Answer 32

( Hypertensive urgency ) occurs when blood pressure spikes — BP 180-220 / 120-140mmHg but there is no damage to body organs It occurs on patient with history of HTN who ( fails to comply with BP medications ) or those who ( have been undermedicated) Hypertensive emergencies occur when there is damage to organs . For examples : ( I) Hypertensive encephalopathy II) Acute renal failure III) Myocardial infarction , Acute left ventricular dysfunction IV) heart failure with pulmonary edema V) eclampsia VI) microangiopathic haemolytic anemia )

Answer 33

1) IHD -> MI 2) Respiratory conditions - COPD , bronchietasis leads to cor pulmonare 3) Valvular heart disease - stenosis , regurgitation 4) Congenital heart disease - ventricular septal defects - patent ductus arteriosus 5) Constrictive pericarditis 6) Hypertensive heart disease 7) Infective endocarditis 8) Cardiomyopathy O) Output failure - anemia , thyrotoxicosis , pregnancy

Answer 34

-Varicella Zoster Virus lies latent in sensory ( DRG , trigeminal ) ganglia after chickenpox infection -> reactivate due to immunosuppression , effect of medication , radio/chemotherapy - usually occurs late ( 50-60yrs ) - C/F : I) Vesticular rash erupts in a dermatomal pattern ( but do not cross the midline ) II) Itching III) Pain , burning sensation - Complications I) post-herpetic neuralgia II) Ramsay-Hunt syndrome ( CNVII involvement ) III) Labryrinthitis -> hearing , balance problems IV) Oral shingles V) Opthalmic shingles -> vision loss VI) Granulomatous angitis Shingles - Infections - MSD Manual Consumer Version

Answer 35

1) Oral , oropharyngeal candidiasis - most common manifestation - angular cheilitis can occur due to Candida infections 2) Hairy leukoplakia - vertical white striations on lateral border of tongue - usually asymptomatic - caused by EBV 3) Oral ulcers - due to HSV, CMV , aphthous ulcers , histoplasmosis 4) Kaposi sarcoma - reddish - purple nodule / papules - affects palate , gums , faucets or tongue

Answer 36

1) HAART ( Highly Active Antiretroviral Therapy ) - 2 NNRTI + 1NRTI / PI / FI - ex : didanosine + lamivudine + nevirapine / lopinavir / raltegralvir 2) Early detection and screening - in high risk individuals , pregnant mothers , transfusion products 3) Use sterile needles 4) Safe sex 5) PPE

Answer 37

1) Western blot assay - more specific diagnostic test - gold standard but expensive and sometimes yield indeterminate results 2) ELISA - diagnostic test 3) p24 antigen & antibody screening 4) PCR 5) CD4 count - >500 cells / mm3 : normal - 200-500 cells /mm3 : low risk of developing major opportunistic infections - <2000 cells/mm3 : severe immune suppression and a high risk of AIDS - defining conditions

Answer 38

1) Candidiasis 2) EBV - oral hairy leukoplakia 3)Penumocystis jirovecii - pneumonia 4) Pulmonary TB 5) Herpes simplex virus infection 6) Herpes zoster

Answer 39

Symptoms - peripheral edema , ascites - hepatomegaly - anorexia , nausea , vomiting - jaundice - fatigue - dyspnoea ,Orthopnea , paroxysmal nocturnal dyspnoea - cough , expectoration , pink frothy sputum Signs - raised JVP - pitting edema - tachycardia - Tachypnoea - peripheral cyanosis - crackles - cardiomegaly - cold clammy skin

Answer 40

The histological hallmark of Hodgkin’s lymphoma is the presence of ( Reed Sternberg cells — large , malignant lymphoid cells of B cells origin )

Answer 41

The hallmark histologic finding of acute myeloid leukaemia is the presence of ( Auer rods )

Answer 42

Leukaemia are a malignant disorder of the ( hematopoietic) stem cell compartment It is associated with an increase in the number of white cells in the ( bone marrow and peripheral blood ) Hematopoietic : red cells , platelets , granulocytes , platelets

Answer 43

Acute leukaemia -> proliferation of primitive stem cells but differentiation is affected -> accumulation of blasts in BM & peripheral blood Chronic leukaemia -> proliferation of primitive stem cells but differentiation is not affected -> accumulation of mature white cells AML - myeloblasts seen CML -> mature myeloid cells seen ALL -> lymphoblasts seen CLL -> mature lymphocytes seen

Answer 44

The characteristics genetic anomaly of chronic myeloid leukaemia ( CML ) is the ( Philadelphia chromosome ) Abnormal fusion gene -> BCR- ABl fusion gene which codes for a protein with tyrosine kinase activity -> cells can proliferate even in absence of regulating signals

Answer 45

Function : 1) Collect CSF sample to investigate infections ( encephalitis , meningitis ) , subarachnoid haemorrhage and inflammatory conditions ( sarcoidosis , MS , cerebral lupus ) 2) Indirect measurement of intracranial pressure Site of insertion - between spinous processes of L3 and L4 , into the subarachnoid space ( lumbar cistern ) - Lumbar puncture ( spinal tap ) - Mayo Clinic

Answer 46

-occurs when a person takes cold food / beverage - leads to rapid vasoconstriction of blood vessels in the palate , followed by rapid vasodilation - rapid change in vessel diameter lead to pain -> transmitted via trigeminal nerve to brain causing a headache - eased by : I) eating / drinking something warm II) putting tongue to roof of palate - increased prevalence in people suffering from migraines

Answer 47

1) Neck pain 2) Fever 3) Photophobia , photophobia 4) Headaches 5) Kernig’s sign - painful knee extension 6) Brudzinski’s sign - passive flexion of neck causes flexion of hips and knees

Answer 48

1) Tension headaches 2) Migraine 3) Sinus headache 4) Cluster / histamine headache 5) Post-traumatic headache 6j Headache due to medication overuse

Answer 49

1) Away from side of lesion - massive pleural effusion - tumors - pneumothorax - cardiomegaly 2) Toward side of lesion - collapse of lung - fibrosis - pneumonectomy

Answer 50

Symptoms 1) fever -> sudden decrease -> warning sign 2) Headache and retro-orbital pain 3) Severe myalgia , bone pain , arthralgia 4) Nausea / vomiting 5) Maculopapular rash over face , thorax & flexor surfaces Signs 1) Thrombocytopenia ( <100k cell/ uL) 2) Increased PT time 3) increased hematocrit 4) Leukopenia , Lymphopenia 5) Hypoproteinemia

Answer 51

DHF ( HEFT ) 1) Thrombocytopenia <100k cells /uL 2) Hemorrhagic manifestation ( epistaxis , gum bleeding , petechia , purpura , ecchymoses , hematemesis , Melena , haematuria , menorrhagia ) 3) Fever 4) Evidence of leaky capillaries ( hypoalbuninemia , effusion , elevated hematocrit 20% over baseline ) DSS - 4 criteria of DHF and : I) Hypotension II) tachycardia and paradoxical Bradycardia III) signs of decreased peripheral effusion ( capillary refill time increased ) IV) hepatomegaly V) Hypothermia VI) Narrow pulse pressure ( <20mmHg )

Answer 52

( NS1 ) antigen detection can help to diagnose dengue fever

Answer 53

In dengue , ( aspirin ) should be avoided to prevent haemorrhage

Answer 54

Cobblestone appearance in intestinal mucosa ( due to ulceration ) appears in ( Crohn Disease ) Pseudoployps appears in ( ulcerative colitis )

Answer 55

Crohn Disease : Ulcerative Colitis Area affected : A) All parts of GIT from mouth to anus , but most commonly distal ilium and proximal colon B) Rectum and colon Layers affected A) Transmral ( mucosa -> submucosa -> muscular layer -> serous ) B) Mucosa and submucosa Predisposing factors A) Common in smokers B) Common in non-smokers and ex-smokers Epidermology A) Common in 2nd & 3rd decade of life , but has a second peak in the 7th decade B) Common in second and third decade of life Clinical features A) - pain in lower right quadrant - Lesions exhibit ‘skip pattern ‘ - presence of fistulations , abscess , fissures ( cobblestone appearances ) B) - Pain in lower left quadrant - Lesions are contiguous - Presence of pseudopolyps Malabsorptions syndrome A) More common due to involvement of small intestine B) Less common

Answer 56

1) Colon cancer 2) Toxic megacolon 3) Hemorrhage 4) Extragit complication

Answer 57

1) Tachycardia - fast and threads pulse 2) Hypotension ( SBP <90mmHg) 3) Cool , clammy skin - warm , Reddish skin in septic shock 4) Oliguria , Anuria 5) Multi-organ failure 6) Dysglycemia 7) Delirium , confusion , stupor , coma 8) Tachypnoea -rapid and shallow breathing 9) Raised JVP in cardio genie , obstructive shock

Answer 58

1) Cardiogenic shock : pump failure - MI -valvular dysfunction - cardiomyopathy - arrhythmias - overdose of Beta-blockers 2) Hypovolemic shock : intravascular volume loss - diarrhea - burns -hemorrhage - vomiting -polyuria eg in diabetic ketoacidosis 3) Distributive shock : excessive vasodilation & impaired distribution of blood flow - sepsis - neurogenic shock - anaphylaxis - systemic inflammatory response system - adrenal insufficiency , thyroid disease 4) Obstructive shock : physical obstruction of blood circulation & inadequate blood oxygenation - tension pneumothorax - cardiac tamponade - pulmonary embolism - aortic dissection - air embolism

Answer 59

1) Resuscitate the patient 2) Infuse 1.0L cystalloid to treat hypotension 3) Dopamine / NE to increase BP 4) Infuse NAHCO3 to correct acidosis 5) Blood transfusions 6) Antibiotics in sepsis 7) Epi in anaphylaxis 8) Insulin in DKA 9) Steroids in adrenal crisis , myxedema coma

Answer 60

1) Intermittent fever - tertian fever -> P.vivax , P. ovale ( 1 day gap) - Quartan fever -> P. Malaria ( 2 day gap ) - P.falciparum has no specific pattern of fever 2) Rigor and chills , sweats 3) Headaches 4) Cough 5)Fatigue , malaise 6) Arthralgia , myalgia - but more severe in dengue 7) Nausea , anorexia , abdominal pain , vomiting 8) Splenomegaly : due to lysis of RBC

Answer 61

1) Cerebral malaria : confusion , coma , convulsion ,neurological sign 2) Blackwater fever - haemoglobinuria due to intravascular haemolysis 3) Respiratory abnormalities - metabolic acidosis - respiratory distress - Pulmonary edema 4) Massive splenomegaly 5) Nephrotic syndrome 6)Severe anemia

Answer 62

1) Blood smears -thin : to identify species - thick : more sensitive 2) Normocytic normochromic anemia 3) ELISA 4) PCR

Answer 63

The drugs used to treat malaria are ( chloroquine and quinine / quinidine )

Answer 64

1) Step ladder pyrexia - characterised by rising temperature over the course of each day that drops by the subsequent morning. The peaks and troughs rise progressively over time. 2) Maculopapular rose spots over the trunk 3) Diffuse abdominal pain and tenderness 4) Colicky right upper quadrant pain 5) Diarrhea

Answer 65

1) Helicobacter pylori infection ( 80% of cases ) - increased HCl secretion - increased gastronomes and pepsinogen - decreased mucus - decreased bicarbonate 2) Use of NSAID except coxibs - inhibit COX-1 enzyme , loss of gastroprotective prostaglandins 3) Hyperactive secretory syndrome ( Zollinger -Ellison syndrome ) - gastrinomas in SI produce gastrin 4) Cushing ulcer - increased intracranial pressure due to tumors , injury or infection -> stimulation of vagal nerve -> increased secretion of gastric acid -> ulcer formation 5) Curling ulcer - seen in severe burn victims - depleted plasma volume leads to ischemia & necrosis of gastric mucosa -> ulcer formation 6)Smoking , alcoholism , certain food - Debatable 7) Genetics - 1st degree relatives are more likely to have PUD

Answer 66

1)Gnawing Epigastric pain - may be dull , vague , or feel like hunger pains 2) Bloating 3) Nausea , vomiting 4) Water brash 5) Appetite changes , weight loss 6) Melena 7) Hematemesis 8) Stomach pain which make you up at night 9) Anemia

Answer 67

1)Endoscopy to detect ulcerations in stomach and duodenum 2) Barium test 3) Fecal bacterial antigen assay 4) Urea breath test 5) Occult blood in stool 6) Measurement of gastric acid or serum gastrin levels

Answer 68

1) Perforations 2) Hemorrhage : leads to anemia 3) Pylori obstruction ( stenosis ) - causes absent bowel sounds

Answer 69

1) To neutralise acid -PPI ( Omeprazole ) , antacids , H2 receptor antagonists ( ranitidine ) 2) Mucosal protective agents - Misoprostol - indicated in patients who cannot withdraw NSAID use 3) To eradicate H .pylori infection - 1 PPI + 2 antibiotics - PPI : Omeprazole , lansoprazole - antibiotics : amoxicillin / metronidazole / clarithromycin

Answer 70

Duodenal. : Gastric Pain 2-3 hours after eating : Onset of pain : Pain immediately after eating Feels better when eating or drinking : After eating or drinking. : Feels worse when eating or drinking Eating. : Relieving factor : Vomiting - : Effect of antacids : Not relieved by antacids

Answer 71

Calcitonin is released by the ( parafollicular cells of thyroid gland ) It’s secretion is stimulated by ( high ) serum calcium levels It ( decreases ) the serum calcium levels by ( increase its uptake by bone , increasing its excretion by kidney ) Parathormone is released by the ( parathyroid gland ) It’s secretion is stimulated by ( low ) serum calcium levels It ( increases ) serum calcium levels by ( increase its mobilisation from the bone and increasing its reabsorption through the kidneys )

Answer 72

- autoimmune disorder - IgG autoantibodies ( TSH receptor antibodies ) are produced -> stimulate thyroid hormone production -> thyrotoxicosis - Clinical features : I) Ophthalmopathy - periorbital edema , Diplopia , exophthalmos’s , conjunctival irritation II) Weight loss III) Goiter IV) Heat intolerance V) Tremors , palpitations , irritability VI) Tachycardia VII) Palmar erythema VIII) Lid Lag IX) occur in females 30-50 y/o

Answer 73

1) Gastric , duodenal ulcer 2) Erosion ( NSAID , alcohol ) 3) Oesophagel varies : seen in portal hypertension 4) Gastritis 5) Mallory - Weiss tear - split in esophagus caused by forceful vomiting 6) Gastric carcinoma 7) Esophagitis 8) Pancreatitis

Answer 74

1) Hemorrhoids 2) Colon cancer 3) Diverculitis 4) Colitis 5) Inflammatory bowel disease 6) Merkel diverticulum

Answer 75

1) Hematemesis - more common in upper GI bleeding ( originate from stomach , esophagus ) - coffee -ground appearance when gastric acid converts hemoglobin -> methemoglobin 2) Melena - more common in upper GI bleeding - passage of black tarry stools 3) Hematochezia - more common in lower GI bleeding - passage of bright red blood from rectum - common in bleeding from colon , rectum , anus 4) Fatigue , weakness , pale skin , shortness of breath -> anemia 5) Abdominal pain 6) Weight loss 7) Jaundice